On a sunny Sunday in June, the staff at Advance Physical Therapy in Chapel Hill, NC invited second year physical therapy students from UNC Chapel Hill to attend a screening for treating pain and dysfunction using Postural Restoration. The experience produced many and varied positive outcomes for all involved. We thought other PRI clinicians might like to know what we learned.
On the students: I teach PT students annually each spring. Inevitably this endeveour culminates in a line of young, high achieving, overworked, overstressed, mostly PEC’s at my door. Further, after years of attending courses within the institute, it seems the most dysfunctional and complex patients are often the PT’s sitting around me. We ourselves realize the profound benefits of PRI most when we feel the effects personally. As with PT practitioners, when PT students are offered plausible mechanisms for their chronic painful states, and more when they are changed by PRI, openness to the approach is enthusiastic. Working with students in this way seems powerful toward the PRI paradigm shift we would like to see within PT. The students also offered helpful feedback with regard to comparing different clinician handling for PRI tests.
On our clinicians: With 12 willing student subjects in the clinic, we couldn’t resist the temptation to try a bit of inter rater reliability among our clinicians for 3 basic PRI screening tests: Adduction Drop Test (ADT), Humeral Glenoid Internal Rotation (HGIR) and Cervical Axial Rotation (CAR).
In looking at our findings, it seems consistency among us was good for ADT and HGIR. Our values for CAR were frankly inconsistent, giving us an opportunity to discuss and problem solve on the utility and practice of CAR, as a group. Related topics entering later discussions included:
- use of pillows and other forms of support during testing to accommodate clinicians capacity and patient comfort – perhaps changing patient tolerance for testing?,
- anthropomorphics influencing decision-making (for example should a short femur on a wide pelvis drop as far as a long femur on a narrow pelvis?),
- unique descriptions and measures during testing ranging from formally measured degrees, to estimates of %, or use of ++, each often with written distinctions for quality of motion and leading to diagnosis and treatment thinking,
- pelvic/hip instability, frank hypermobility influencing test results, esp. false negatives?,
- SI dysfunction perhaps influencing test results in strange patterns like + R ADT, - L ADT?,
- repeated testing influencing test results?
On our clinic as a whole: All together at a follow up meeting, we watched each other do these same tests, this time on one subject, to discuss our individual thinking without the “blinding” we employed with the students. In the end we discovered we each employed unique positioning and preferences for support. Our collective descriptions, thinking and rationale for ratings were insightful and got us all looking more creatively about our own process with a greater likelihood of being in the same neighborhood, if not exactly the same page as our fellow PRI clinicians.